Organization
GENESEE VALLEY GROUP HEALTH ASSOCIATION
Active
Other names
Lifetime Health Medical Group
Organization subpart
No
Provider details
NPI number
Authorized official
DEBORAH CARLASCIO (VICE PRESIDENT REGIONAL OPERATIONS)
(585) 338-1400
Entity
Organization
Contact information
Practice address
130 EMPIRE DR, WEST SENECA, NY 14224-1320
(716) 668-6170
(716) 656-4074
Mailing address
130 EMPIRE DR, WEST SENECA, NY 14224-1320
(716) 668-6170
(716) 656-4074
Taxonomy
Speciality
Code
Description
License number
State
133NN1002X
Nutrition Education Nutritionist
—
—
136A00000X
Registered Dietetic Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00011283017
GROUP # FOR HCP NUTRITION
NY
Enumeration date
03/22/2007
Last updated
09/11/2025
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